BMJ  2003;327:480 (30 August), doi:10.1136/bmj.327.7413.480

Primary care

Influence of environmental factors on mental health within prisons: focus group study

¹ North and Mid Hampshire Health Authority, Harness House, Basingstoke, Hampshire RG24 9NB, ² Ravenswood House, Knowle, Fareham, Hampshire PO17 5NA

Objective To increase understanding of how the prison environment influences the mental health of prisoners and prison staff.

Design Qualitative study with focus groups.

Setting A local prison in southern England.

Participants Prisoners and prison staff.

Results Prisoners reported that long periods of isolation with little mental stimulus contributed to poor mental health and led to intense feelings of anger, frustration, and anxiety. Prisoners said they misused drugs to relieve the long hours of tedium. Most focus groups identified negative relationships between staff and prisoners as an important issue affecting stress levels of staff and prisoners. Staff groups described a "circle of stress," whereby the prison culture, organisation, and staff shortages caused high staff stress levels, resulting in staff sickness, which in turn caused greater stress for remaining staff. Staff shortages also affected prisoners, who would be locked up for longer periods of time, the ensuing frustration would then be released on staff, aggravating the situation still further. Insufficient staff also affected control and monitoring of bullying and reduced the amount of time in which prisoners were able to maintain contact with their families.

Conclusions Greater consideration should be given to understanding the wider environmental and organisational factors that contribute to poor mental health in prisons. This information can be used to inform prison policy makers and managers, and the primary care trusts who are beginning to work in partnership with prisons to improve the mental health of prisoners.

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